| Name: | Fort Payne MRI, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Sep 2005 (19 years ago) |
| Entity Number: | 000-468-701 |
| Register Number: | 000468701 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 7094 UNIVERSITY COURTMONTGOMERY, AL 36117 |
| Registered Office Street Address ZIP Code: | 36117 |
| Principal Address: | MONTGOMERY, AL |
Activities
MAGNETIC IMAGING FACILITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730145988 | 2006-04-25 | 2008-02-22 | 1110 GLENN BLVD SW, SUITE 100, FORT PAYNE, AL, 359678486, US | 1110 GLENN BLVD SW, SUITE 100, FORT PAYNE, AL, 359678486, US | |||||||||||||||||||||
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| Phone | +1 256-845-9402 |
| Fax | 2568459410 |
Authorized person
| Name | JAMES W. HOLMES |
| Role | CHIEF OPERATING OFFICER |
| Phone | 3372919161 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051557560 |
| State | AL |
| CIK number | Mailing Address | Business Address | Phone | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1342665 | 2170 ROSEMONT DR, MONTGOMERY, AL, 36111 | 2170 ROSEMONT DR, MONTGOMERY, AL, 36111 | 334-834-1300 | |||||||||
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| Form type | REGDEX |
| File number | 021-82590 |
| Filing date | 2005-10-24 |
| File | View File |
| Name | Role | Address |
|---|---|---|
| BARNETT, ROSS W | Agent | 255 ALBERT RAINES BLVDGADSDEN, AL 35901 |
| Name | Role |
|---|---|
| OPEN MRI OF ALABAMA LLC | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
